Absolute risk of cardiovascular disease and lipid management targets.

Traditionally, the relative risk has been primarily used to evaluate the strength of the associations between risk factors and cardiovascular disease (CVD) and the effects of treatment. In Western countries, scoring tables consisting of scores for each risk factor weighted according to their absolute risk and risk assessment charts in which squares at the points of intersection of the vertical and horizontal axes, each of which has a different risk factor at a different level, are expressed in different colors to represent the absolute risk have been developed to predict an individual's absolute risk in several guidelines. Typical examples are the U.S. Framingham risk score 1) and the Euro-pean SCORE risk chart 2). As the name implies, the Framingham risk score is a method for scoring sex (the weighting of each risk factor differs between men and women), age, total cholesterol (TC), the smoking status , high density lipoprotein cholesterol (HDL-C) and systolic blood pressure. The probability of developing coronary artery disease (CAD), coronary death and nonfatal myocardial infarction within 10 years is calculated from the sum of the scores. The SCORE is a risk assessment chart method used to calculate the probability of death due to all CVD, including stroke, within 10 years based on sex, age, TC, the smoking status and systolic blood pressure. Because the mortality of CVD differs between countries even at the same level of risk factors, the SCORE risk chart is classified into two types: one used in countries with low cardio-vascular mortality (e.g., France and Italy) and the other used in countries with high mortality (e.g., the U.K. and Germany). In Japan, where the size of the aging population is increasing, the concept of absolute risk is important for the management of risk factors for CVD in terms of determining the priority of treatment options and promoting efficient preventive strategies. In addition to the J-LIT chart for dyslipidemia 3) , many risk assessment tools for predicting CVD based on cohort studies in the general population have recently been published in Japan 4-9). This chapter explains the background and rationale of classifying patients according to absolute risk and the management targets for dys-lipidemia in each category. was used as source data to establish the absolute risk for the following reasons: 1) There was no regional bias, as approximately 10 thousand people living in 300 districts were randomly selected throughout Japan for the evaluation; 2) …